Eating Disorders – article by Emma Thomas
Eating disorders affect over 900,000 Australians each year. The mortality rate for eating disorders is of great concern, and is the highest of the psychiatric illnesses (over 20%), given its physiological complications and link with suicide. Around 1900 Australians died last year as a result of an eating disorder. Furthermore, they are also strongly associated with other distressing mental disorders such as anxiety, depression, personality disorders and substance abuse issues. Contributing to the high mortality rate is the reluctance to seek help, with less than 30% of people experiencing an eating disorder seeking help for their disorder.
In early March 2015, the Deloitte Access Economics report stated that eating disorders would cost over $27 billion of taxpayer money over the next 10 years, while better intervention initiatives would cost only $2.8 billion over this period.
It is not surprising, therefore, that one of the key actions from the Mental Health Commission’s 2015 strategic plan is to ensure adequate training is provided to all staff in mental health services in the recognition, assessment, referral pathways and treatment of eating disorders. A further outcome from the plan is to prioritise the development of community-based care models. Both of these actions will promote earlier intervention and will help people to get more effective help in a timely manner.
What is an eating disorder?
An eating disorder is a serious mental health illness which involves having an unhealthy preoccupation with eating and/or exercise and body shape/weight. It is important to understand that an eating disorder can be extremely dangerous, and should be acknowledged as distinctive from a diet, fad, or attempt to seek attention.
There are a number of different types of eating disorders, the most common being Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. These will be discussed in greater detail later in the article.
How do I know if my child has an eating disorder?
There are a number of different behavioural, physical and psychological warning signs for parents to watch out for. The Butterfly Foundation outlines the below warning signs for parents. If your child is experiencing several of the below, it is important to seek help from a professional.
· Withdrawal from social events and activities that they used to enjoy
· A focus on diets, calories, health and particular foods. They might talk about wanting to be healthier or fitter and become obsessive about checking the nutritional content of what they are eating.
· They might become irritable or anxious around dinner time. They may refuse to eat certain foods or whole food groups.
· Complaints about the way they look, e.g. “I’m ugly” or “I’m fat”, or negative comments about their abilities, e.g. “I’m hopeless”
· Frequent weight changes or rapid weight loss
· Change in clothing style such as wearing baggy or oversized clothing
Causes of Eating Disorders
There is no single cause of developing an eating disorder. However, the National Eating Disorders Collaboration Australia has identified certain risk factors:
Genetic vulnerability
There is some evidence links the inheritance of certain genes that relate to appetite, mood, metabolism, food intake and reward-pleasure responses. However, the biological cause of eating disorders is not clear cut, due to the fact that studies are conducted post development of an eating disorder, which could have had an impact on the findings, therefore making it difficult to establish a direct ‘cause and effect’ relationship.
Psychological factors
Certain personality traits are known to be linked to the development of eating disorders, particularly to that of Anorexia Nervosa and Bulimia Nervosa:
· obsessive-compulsiveness
· neuroticism
· core low self-esteem
· negative emotionality
· perfectionism
· harm avoidance
· traits associated with avoidant personality disorder
However, once again the direct ‘cause and effect’ relationship is difficult to identify due to the impact that eating disorders have on the people’s thoughts, emotions and behaviours.
Socio-cultural influences
Those who take on the Western beauty ideal of the “perfect body” can be at risk of developing an eating disorder. Images in the media show unattainable images of beautiful slim women, and handsome muscled men, which encourage body dissatisfaction.
What can I do to help my child develop a healthy relationship with food, exercise and weight?
Parents play a key role in their child’s relationship with food and body image. Here are some tips for parents from Kasey Edwards, best-selling author and expert in body image among young girls:
1. Never talk about body weight
Kasey advises never to talk about your own weight or your looks at all in a negative manner. When others talk about weight in front of your children, do your best to neutralise it. This will help to teach them that looks and weight are unrelated to self-worth.
2. Never talk about food in terms of calories or what’s fattening
Speak instead about the nutritional value of food.
3. Don’t ban certain foods
It is important not to classify foods into black and white categories of good and bad, as this is not the case with most foods. Some processed foods are reasonable at times as they taste good and are part of certain social rituals (e.g. birthday cake) but don’t contribute to making us fit and healthy and strong. Classifying foods as “bad” can create closet eaters who sneak away these “bad” foods and eat them in secret.
4. Try limiting “rules” around food
Kasey suggests having only one rule such as “you must eat something of everything on your plate” to ensure a wide variety of nutrients. Additionally, she does not recommend forcing a child to eat if they do not feel hungry as this encourages them to be in charge of their own appetite and can avoid food wars or dining table power struggles.
5. Focus on how bodies work rather than how they look
Celebrate the amazing things one can do with their body — such as running, jumping, skipping, and rolling. This will help to teach them to value their body for what it can do instead of what it looks like.
What about if my child gets diagnosed with an eating disorder?
The National Eating Disorders Collaboration of Australia Offers 7 tips for families and carers of those people with an eating disorder:
· Read up on eating disorders and learn as much as you can about how to treat them better. This will also enable you to better understand their point of view and what they are going through.
· Remember who the person is – they are more than just their illness. Help them to regain their sense of identity outside of the disorder.
· Open the lines of communication. Ensure you express how you are feeling but avoid judgement and negativity. Also encourage them to express their feelings openly and honestly.
· Try to stay positive in your own mind and about them. Talk about future plans and point out their positive attributes and strengths to build their self-esteem.
· Ensure you are engaging in self-care. Acknowledge that you have a tough role to play and make time to relax and do things to restore your energy so you are in better shape to care for your loved one.
· Be patient and try to remember that recovery from an eating disorder is a slow process and takes time and perseverance.
· Get professional support for yourself and for your loved one. This will help ease the stress that is associated with suffering from and caring for someone with an eating disorder.
What are my rights?
You have the right to medical treatment if you fear for the life of your child. The Australian Government Department of Health states that health professionals are legally required to ensure safety, as they have a 'duty of care'. For example, involuntary admission into hospital, which is covered by the Mental Health Act.
Even if your child doesn’t want help, when a person with an eating disorder refuses treatment, parents or carers may obtain a 'legal order' that allows them to take temporary control over the patient and make decisions on their behalf to authorise medical or psychiatric treatments. This is of course used only for the purpose of saving a life when all other options fail.
In Australia, persons over the age of 14 can seek a confidential medical consultation. If your child is younger than 14 then you will be included in all discussions about your child’s health. For those over 14, only that information which your child agrees to share can be shared by the health professional.
Types of Eating Disorders
The Mental Health Association of NSW outlines the following types of eating disorders, their specific symptoms, and possible treatments:
Anorexia Nervosa
People who intentionally starve themselves may be experiencing an eating disorder called anorexia nervosa. This disorder, which often begins in young people around the time of puberty, involves extreme weight loss - at least 15% below the individual's normal body weight. Some people with the disorder may look emaciated however are convinced they are overweight. At times they must be hospitalised to prevent starvation. People with anorexia typically starve themselves, even though they may experience severe hunger pains. One of the most frightening aspects of the disorder is that people with anorexia continue to think they are overweight even when they are exceptionally thin. For reasons not yet understood, they can become terrified of gaining any weight.
Food and weight can become obsessions. For some, the compulsiveness shows up in strange eating rituals or the refusal to eat in front of others. It is not uncommon for people with anorexia to collect recipes and prepare gourmet feasts for family and friends, but not partake in the meals themselves. They may adhere to strict exercise routines to keep off weight. Loss of monthly menstrual periods is typical in women with the disorder. Men with anorexia often become impotent.
Specific Symptoms of this Disorder
A person who suffers from this disorder is typically characterised by their refusal to maintain a body weight, which is consistent with their build, age and height. The individual usually experiences an intense and overwhelming fear of gaining weight or becoming fat. This fear is regardless of the person's actual weight, and will often continue even when the person is near death from starvation. It is related to a person's poor self-image, which is also a symptom of this disorder. The individual suffering from this disorder believes that their body weight, shape and size is directly related to how good they feel about themselves and their worth as a human being. People with this disorder often deny the seriousness of their condition and cannot objectively evaluate their own weight.
Physical Effects
· Chronic indigestion
· Loss of motivation
· Chemical imbalances
· Severe sensitivity to the cold
· Loss or thinning of hair
· Skin and nail problems
· Growth of fine body hair known as ‘lanugo’
· Severe weight loss
Treatment
The treatment of this disorder is often difficult. This is due to the insidious nature of the disorder that wreaks havoc not only with the body, but just as seriously with the individual's negative self-perception. Starvation is not an immediate concern of most individuals who present with this disorder, but body weight and nutrition should be thoroughly evaluated at the onset of therapy. A complete medical examination is usually warranted to evaluate the person's health and medical status. Underweight individuals often experience many medical complications.
The first line treatment for people experiencing anorexia nervosa is a combination of a structured eating plan with nutrition and psychotherapy.
Psychotherapy
Psychotherapy needs to focus on a number of issues after a therapeutic, trusting relationship has been established. The most powerful issue is the obsession with body image, which is also the most difficult to change.
Hospitalisation
Hospitalisation of anybody experiencing mental distress can often be a confusing and emotionally wrought decision. Family members or significant others may need to intervene in the person life to ensure they do not starve themselves to death. In these cases, hospitalisation is not only necessary but also a prudent treatment intervention. Family members should be aware that individuals who have anorexia nervosa will often resist treatment of any sort, especially hospitalisation. It is important, therefore, to come to an agreement about the need for such a step and not be swayed by the person's pleas for seeking alternative treatment options. Often these have already been tried with no success.
Medications
Some medications can be extremely helpful in treatment of a person with anorexia nervosa. As always, the medication should be carefully monitored, especially since the person may be vomiting which may impact on the medication's effectiveness. A trusting and honest relationship must be established between the physician and the individual or medication compliance will almost certainly become an issue.
Anti-depressants (selective serotonin re-uptake inhibitors such as Prozac or Zoloft) are the usual drug treatment and may speed up the recovery process. Chlorpromazine may be beneficial for those individuals experiencing severe obsessions and increased anxiety and agitation.
Self-Help
Self-help support groups are an especially powerful and effective means of ensuring the engagement in long-term treatment and decrease the rate of relapse to starving behaviours. Individuals find they can share ideas and experiences with one another, obtain objective feedback about body image and find increased social support. Many support groups exist within communities throughout the world that are devoted to helping individuals with this disorder share their common experiences and feelings.
Bulimia Nervosa
People with bulimia nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some people use a combination of all these forms of purging. Because many individuals with bulimia ‘binge and purge’ in secret and maintain normal or above normal body weight, they can often successfully hide their problem from others for years.
Family, friends, and physicians may have difficulty detecting bulimia in someone they know. Many individuals with the disorder can remain at normal body weight or slightly above. Dieting heavily between episodes of binging and purging is also common.
As with anorexia, bulimia often begins during adolescence. The condition occurs most often in women but is also found in men. Many individuals with bulimia may find themselves ashamed of their habits, and may not seek help until they reach their thirties or forties. By this time, their eating behaviour is deeply ingrained and more difficult to change.